Summary about Disease
Myelitis refers to inflammation of the spinal cord. This inflammation can damage or destroy myelin, the protective insulation covering nerve fibers, as well as the nerve fibers themselves. This damage disrupts the communication between the brain and the rest of the body, leading to a range of neurological problems. Different types of myelitis exist, classified by the cause and location of the inflammation within the spinal cord. Transverse myelitis, a specific type, involves inflammation across the entire width of the spinal cord.
Symptoms
Symptoms vary depending on the severity and location of the inflammation, but common symptoms include:
Weakness in arms or legs: Ranging from mild heaviness to complete paralysis.
Sensory alterations: Numbness, tingling, burning, coldness, or reduced sensation to touch, temperature, and pain. These sensations may affect the arms, legs, trunk, or face.
Pain: Localized pain in the back or neck, or shooting pains down the arms or legs (Lhermitte's sign).
Bowel and bladder dysfunction: Difficulty starting urination, urinary frequency, urgency, incontinence, constipation, or bowel incontinence.
Spasticity: Muscle stiffness, tightness, and involuntary muscle spasms.
Sexual dysfunction: Erectile dysfunction, decreased libido, or difficulty achieving orgasm.
Causes
Myelitis can be caused by a variety of factors:
Infections: Viral infections (e.g., herpesviruses, enteroviruses, HIV, West Nile virus), bacterial infections (e.g., tuberculosis, syphilis), and fungal infections can trigger myelitis.
Autoimmune disorders: Conditions like multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), systemic lupus erythematosus (SLE), and Sjogren's syndrome can cause inflammation in the spinal cord.
Inflammatory conditions: Sarcoidosis
Vaccinations: In rare instances, some vaccinations have been associated with myelitis.
Idiopathic: In many cases, the cause remains unknown (idiopathic myelitis).
Spinal cord injury Trauma to the spinal cord may cause myelitis.
Medicine Used
Treatment focuses on reducing inflammation, managing symptoms, and preventing complications. Medications used may include:
Corticosteroids: (e.g., methylprednisolone, prednisone) to reduce inflammation.
Antiviral medications: (e.g., acyclovir) if a viral infection is identified as the cause.
Plasma exchange (PLEX) or intravenous immunoglobulin (IVIg): May be used to remove harmful antibodies or modulate the immune system.
Pain relievers: Over-the-counter or prescription pain medications to manage pain.
Muscle relaxants: (e.g., baclofen, tizanidine) to alleviate spasticity.
Bowel and bladder medications: To manage bowel and bladder dysfunction.
Immunosuppressants: (e.g., azathioprine, methotrexate, rituximab) to suppress the immune system in autoimmune-related myelitis.
Is Communicable
Myelitis itself is generally not communicable. However, if the myelitis is caused by a specific infection (e.g., viral or bacterial), the underlying infection may be communicable. The risk of transmission depends on the specific infectious agent involved.
Precautions
Precautions depend on the cause of the myelitis. If the cause is infectious, standard infection control measures (handwashing, avoiding close contact with infected individuals) are important. If the myelitis is related to an autoimmune disorder, following the treatment plan prescribed by your doctor (including medications and lifestyle modifications) is crucial. In general, for any type of myelitis, it's important to:
Follow your healthcare provider's recommendations.
Maintain a healthy lifestyle (balanced diet, regular exercise if possible, adequate sleep).
Prevent falls and injuries due to weakness or sensory loss.
Monitor for complications such as pressure sores, urinary tract infections, and respiratory problems.
How long does an outbreak last?
The duration of a myelitis outbreak varies greatly depending on the cause, severity, and individual response to treatment.
Acute myelitis: Symptoms may develop rapidly over hours to days and reach their peak within days to weeks. Improvement may begin within weeks or months, but some residual deficits may persist.
Chronic myelitis: Symptoms may develop gradually over weeks or months and may be progressive or relapsing-remitting. The duration can extend for months, years, or even be lifelong. The term “outbreak” is not typically used to describe Myelitis as it's not a disease that would have an “outbreak” of cases, it refers to the initial onset of the symptoms and inflammation in the spine.
How is it diagnosed?
Diagnosis typically involves:
Neurological examination: To assess motor strength, sensation, reflexes, and coordination.
Medical history: To gather information about symptoms, past illnesses, vaccinations, and family history.
MRI of the spinal cord: To visualize inflammation or lesions in the spinal cord.
Lumbar puncture (spinal tap): To analyze cerebrospinal fluid (CSF) for signs of infection, inflammation, or abnormal antibodies.
Blood tests: To screen for infections, autoimmune disorders, and other potential causes.
Evoked potentials: To assess the electrical activity of the spinal cord and nerves.
Timeline of Symptoms
The timeline of symptoms can vary greatly.
Acute onset: Symptoms develop rapidly over hours to days, reaching a peak within days to weeks.
Subacute onset: Symptoms develop more gradually over days to weeks.
Chronic onset: Symptoms develop gradually over weeks to months or longer. Symptoms may progress, stabilize, or improve over time, depending on the cause and treatment response.
Important Considerations
Early diagnosis and treatment are crucial to minimize long-term disability.
Rehabilitation therapy (physical therapy, occupational therapy) is essential to regain function and improve quality of life.
Psychological support may be beneficial to cope with the emotional and psychological impact of myelitis.
Long-term follow-up is necessary to monitor for complications and manage symptoms.
Myelitis can significantly impact daily life, affecting mobility, sensation, bowel/bladder control, and overall independence.
Patients may experience chronic pain, fatigue, and depression.
The prognosis for myelitis varies depending on the cause, severity, and individual response to treatment. Some individuals may recover fully, while others may have permanent disabilities.